Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH.
Department of Radiology University of Arkansas for Medical Sciences Little Rock AR.
J Am Heart Assoc. 2024 Jun 4;13(11):e031632. doi: 10.1161/JAHA.123.031632. Epub 2024 May 28.
Pregnancy in patients with pulmonary hypertension (PH) is associated with a heightened risk of medical complications including right heart failure, pulmonary edema, and arrhythmias. Our study investigated the association between PH and these complications during delivery.
The National Inpatient Sample was used to identify delivery hospitalizations from 2011 to 2020. Multivariable logistic regression was performed to study the association of PH with the primary outcomes of in-hospital medical and obstetric complications. A total of 37 482 207 delivery hospitalizations in women ≥18 years of age were identified, of which 9593 patients had PH. Pregnant patients with PH had higher incidence of complications during delivery including preeclampsia/eclampsia, arrhythmias, and pulmonary edema among others, compared with those without PH. Pregnant patients with PH also had a higher incidence of in-hospital mortality compared with those without PH (0.51% versus 0.007%). In propensity-matched analyses, PH was still significantly associated with a higher risk of in-hospital mortality (odds ratio [OR], 5.02 [95% CI, 1.82-13.90]; =0.001), pulmonary edema (OR, 9.11 [95% CI, 6.34-13.10]; <0.001), peripartum cardiomyopathy (OR, 1.85 [95% CI, 1.37-2.50]; <0.001), venous thromboembolism (OR, 12.60 [95% CI, 6.04-26.10]; <0.001), cardiac arrhythmias (OR, 6.11 [95% CI, 4.97-7.53]; <0.001), acute kidney injury (OR, 3.72 [95% CI, 2.86-4.84]; <0.001), preeclampsia/eclampsia (OR, 2.24 [95% CI, 1.95-2.58]; <0.001), and acute coronary syndrome (OR, 2.01 [95% CI, 1.06-3.80]; =0.03), compared with pregnant patients without PH.
Delivery hospitalizations in patients with PH are associated with a high risk of mortality, pulmonary edema, peripartum cardiomyopathy, venous thromboembolism, arrhythmias, acute kidney injury, preeclampsia/eclampsia, and acute coronary syndrome.
患有肺动脉高压 (PH) 的孕妇发生医疗并发症的风险较高，包括右心衰竭、肺水肿和心律失常。我们的研究调查了 PH 与分娩期间这些并发症的关系。
利用国家住院患者样本，确定了 2011 年至 2020 年分娩住院治疗情况。多变量逻辑回归用于研究 PH 与住院期间主要医疗和产科并发症的关系。在年龄≥18 岁的女性中，共确定了 37482207 例分娩住院患者，其中 9593 例患有 PH。与没有 PH 的孕妇相比，患有 PH 的孕妇在分娩期间更易发生并发症，包括子痫前期/子痫、心律失常和肺水肿等。与没有 PH 的孕妇相比，患有 PH 的孕妇院内死亡率也更高（0.51%比 0.007%）。在倾向匹配分析中，PH 与院内死亡率升高仍显著相关（比值比 [OR]，5.02 [95%置信区间，1.82-13.90]；=0.001）、肺水肿（OR，9.11 [95%置信区间，6.34-13.10]；<0.001）、围产期心肌病（OR，1.85 [95%置信区间，1.37-2.50]；<0.001）、静脉血栓栓塞症（OR，12.60 [95%置信区间，6.04-26.10]；<0.001）、心律失常（OR，6.11 [95%置信区间，4.97-7.53]；<0.001）、急性肾损伤（OR，3.72 [95%置信区间，2.86-4.84]；<0.001）、子痫前期/子痫（OR，2.24 [95%置信区间，1.95-2.58]；<0.001）和急性冠状动脉综合征（OR，2.01 [95%置信区间，1.06-3.80]；=0.03），与没有 PH 的孕妇相比。
患有 PH 的孕妇分娩时，死亡风险、肺水肿、围产期心肌病、静脉血栓栓塞症、心律失常、急性肾损伤、子痫前期/子痫和急性冠状动脉综合征的风险较高。
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